Metabolic syndrome and risk of incident psoriasis: prospective data from the HUNT Study, Norway.

BACKGROUND: Metabolic syndrome has been associated with psoriasis in cross-sectional studies, but data from prospective studies are sparse. OBJECTIVES: To examine prospectively whether metabolic syndrome and its components are associated with the risk of incident psoriasis in a large population-based study using objective measurements of cardiovascular disease risk factors. METHODS: We used data from two consecutive surveys of the HUNT Study, Norway (HUNT2, 1995-1997, and HUNT3, 2006-2008). In total 34 996 women and men aged ≥ 20 years without psoriasis in HUNT2 were followed up in HUNT3, and 374 incident cases of psoriasis were identified. We used Cox regression to estimate the adjusted relative risk (RR) of incident psoriasis with its 95% confidence interval (CI). RESULTS: Metabolic syndrome was associated with an RR for psoriasis of 1·66 (95% CI 1·30-2·14). To explore the influence of adiposity on this association, we first excluded waist circumference from the definition of metabolic syndrome (adjusted RR 1·54, 95% CI 1·14-2·07) and then adjusted for body mass index (RR 1·33, 95% CI 0·97-1·81). Analyses of the separate components of metabolic syndrome showed positive associations with risk of psoriasis for waist circumference, triglycerides and high-density lipoprotein (HDL) cholesterol, but not for blood pressure or blood glucose. There was also an increased risk of psoriasis for high total cholesterol. The increased risk associated with high triglycerides, HDL cholesterol and total cholesterol was attenuated after adjusting for body mass index. CONCLUSIONS: In this large prospective study from a general population, we found that metabolic syndrome was associated with increased risk of incident psoriasis, and our results suggest that this positive association could, at least partly, be attributed to adiposity.

Psoriasis and cardiovascular disease risk factors: the HUNT Study, Norway.

BACKGROUND: Studies have examined the associations between psoriasis and cardiovascular diseases and their risk factors, but the results are conflicting, especially in the general population. OBJECTIVES: To investigate the association of psoriasis, and in particular psoriasis severity, with objectively measured cardiovascular disease risk factors and cardiovascular morbidity in a large population-based cross-sectional study. METHODS: We linked data on 50 245 persons in the HUNT3 Study, Norway, with information from the National Prescription Database to obtain information on use of psoriasis medication. A total of 2894 persons reported to have psoriasis; 2643 were classified as mild; and 251 as moderate/severe psoriasis. We used linear and logistic regression to estimate adjusted associations with 95% confidence intervals (CIs) between psoriasis and cardiovascular disease risk factors and morbidity. RESULTS: We observed a positive association between psoriasis and objective measures of body mass index (BMI), waist circumference and high-sensitivity C-reactive protein, but no clear association with blood pressure and blood lipids. People with moderate/severe psoriasis had an odds ratio for being overweight of 1.94 (95% CI 1.42, 2.67), whereas the odds ratio for metabolic syndrome was 1.91 (95% CI 1.47, 2.49). Psoriasis was also positively associated with self-reported diabetes, myocardial infarction and angina pectoris. CONCLUSIONS: In this population-based study, we found that psoriasis was positively associated with measures of adiposity, as well as with a clustering of cardiovascular disease risk factors. Overall, these associations were strongest for people with moderate/severe psoriasis.

The association between the clinical diversity of psoriasis and depressive symptoms: the HUNT Study, Norway.

BACKGROUND: While a number of observational hospital-based studies have reported an association between psoriasis and depression, less is known about the clinical diversity of psoriasis and depressive symptoms. OBJECTIVE: To investigate the associations of inverse psoriasis, psoriasis severity and psoriasis duration with depressive symptoms in a general population. METHODS: We linked data from the population-based third Nord-Trøndelag Health Study (HUNT3) to the Norwegian Prescription Database (NorPD) and Statistics Norway. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Associations between psoriasis and depressive symptoms (HADS ≥ 8) were estimated using logistic regression. RESULTS: Among 37 833 participants in HUNT3, we found a weak association between any psoriasis and the prevalence of depressive symptoms [fully adjusted odds ratio (OR) 1.12, 95% confidence interval (CI) 0.97-1.28]. The association with depressive symptoms was stronger when psoriasis was characterized by inverse anatomical distribution (OR 1.32, 95% CI 1.02-1.70), requirement of systemic psoriasis medication (OR 1.47, 95% CI 1.00-2.17) or long disease duration (OR 1.33, 95% CI 1.09-1.64). Conversely, when there was no inverse psoriasis distribution, no requirement of systemic medication, or shorter disease duration, psoriasis was not meaningfully associated with depressive symptoms. CONCLUSION: Overall, depressive symptoms do not seem to be a major concern among subjects with psoriasis in a general Norwegian population. However, among subjects with inverse anatomical distribution, requirement of systemic psoriasis medication or long disease duration, depressive symptoms may be particularly important to address when evaluating the burden of psoriasis.

Psoriasis, fracture risk and bone mineral density: the HUNT Study, Norway.

BACKGROUND: An association between psoriasis and osteoporosis has been reported. OBJECTIVES: To investigate, in a large prospective population-based Norwegian study, whether psoriasis is associated with increased risk of forearm or hip fracture; to investigate the cross-sectional association between psoriasis and bone mineral density (BMD) T-score in a subpopulation. METHODS: Hospital-derived fracture data from Nord-Trøndelag County (1995-2013) were linked to psoriasis information, BMD measurements and lifestyle factors from the third survey of the Nord-Trøndelag Health Study 2006-08 (HUNT3); socioeconomic data from the National Education Database; and use of medication from the Norwegian Prescription Database. RESULTS: Among 48 194 participants in HUNT3, we found no increased risk of forearm or hip fracture in 2804 patients with self-reported psoriasis [overall age- and sex-adjusted hazard ratio 1·03, 95% confidence interval (CI) 0·82-1·31]. No clear association was found between psoriasis and mean BMD T-score; overall age- and sex-adjusted differences in total hip, femoral neck and lumbar spine BMD T-scores were 0·02 (95% CI -0·11 to 0·14), 0·05 (95% CI -0·06 to 0·17) and 0·07 (95% CI -0·09 to 0·24), respectively. No clear association was found between psoriasis and prevalent osteoporosis in either total hip, femoral neck or lumbar spine; overall age- and sex-adjusted odds ratio was 0·77 (95% CI 0·54-1·10). Associations did not change substantially after adjustment for education, smoking, systemic steroid use and body mass index. CONCLUSIONS: We found no association between psoriasis and risk of fracture. The study did not indicate reduced BMD T-score or higher prevalence of osteoporosis among patients with psoriasis.

Incidence of primary cutaneous T-cell lymphoma in Norway.

BACKGROUND: Studies from different countries have reported an increased incidence of primary cutaneous lymphomas over the last decades. OBJECTIVES: To estimate the incidence rates of primary cutaneous T-cell lymphoma (CTCL) and mycosis fungoides (MF)/Sézary syndrome (SS) in Norway, and to compare these rates with those reported from other countries. METHODS: Data from the Cancer Registry of Norway on non-Hodgkin lymphomas during the period 1980-2003 were analysed. RESULTS: In total, 337 cases of CTCL were reported to the Cancer Registry during the study period, of which 262 cases were classified as MF/SS. The incidence rate of CTCL increased significantly (P(trend) < 0.001) from 0.16 (95% confidence interval, CI 0.11-0.20) per 100,000 person-years in 1980-84 to 0.29 (95% CI 0.22-0.36) per 100,000 person-years in 2000-2003. The incidence of MF/SS also increased during the same period (P(trend) = 0.05) from 0.15 (95% CI 0.10-0.19) per 100,000 person-years to 0.18 (95% CI 0.13-0.24) per 100,000 person-years. CONCLUSIONS: The incidence of both CTCL and MF/SS increased in Norway during the period 1980-2003.

In vitro experiments demonstrate that monocytes and dendritic cells are rendered apoptotic by extracorporeal photochemotherapy, but exhibit unaffected surviving and maturing capacity after 30 Gy gamma irradiation.

Extracorporeal photochemotherapy (ECP) has been shown to induce apoptosis in lymphocytes. Until recently the prevailing opinion has been that the monocytes were mainly not affected by this treatment. This study has investigated the effect of ECP and gamma irradiation on monocytes and immature dendritic cells (DC) in vitro and followed the ability of the cells to differentiate and survive post treatment. ECP induced apoptosis in lymphocytes, monocytes and immature DC within 72 h following treatment, in contrast to 30 Gy gamma irradiation, which seemed mainly to affect lymphocytes. The minority of the surviving ECP-treated monocytes presented a reduced ability to differentiate into immature DC within this time frame. We also demonstrated that immature DC after ECP-treatment lost their normal ability to mature on stimulation with lipopolysaccharide. As monocytes and immature DC seem to have a reduced ability to differentiate after ECP-treatment, it is suggested that the therapeutic effect of ECP is caused by in vivo effects of reinfused apoptotic cells, rather than by infusion of monocytes induced to differentiate into immature DC.

Atopic dermatitis in adolescent boys is associated with greater psychological morbidity compared with girls of the same age: the Young-HUNT study.

BACKGROUND: Having atopic dermatitis (AD) as well as other chronic diseases is often associated with reduced mental health. Adolescents with AD are thought to be especially vulnerable, but few studies have included an ample number of young people. OBJECTIVES: To study self-reported mental distress among boys and girls 13-19 years of age with AD compared with mental distress among healthy adolescents as well as mental distress among adolescents with other chronic diseases or complaints, such as headache, neck or shoulder pain, asthma, allergy and rhinitis. METHODS: The Young-HUNT study was conducted as a cross-sectional, population-based survey in 1995-97. All students in Nord-Trondelag County, Norway, aged 13-19 years were invited, and some 89% participated. A questionnaire on mental and somatic health, life-style and social conditions was completed during one school hour. RESULTS: A total of 4384 girls and 4433 boys participated. The prevalence of mental distress was higher among older teenagers, and more than every fourth girl aged 17-19 reported mental distress. Although more girls than boys reported mental distress, AD, headache and neck or shoulder pain, the odds for reporting both AD and mental distress were higher for boys [odds ratio (OR) = 2.1 (1.6-2.9)] compared with girls [OR = 1.3 (1.1-1.6)]. A corresponding sex difference in reporting mental distress was also seen for some other chronic diseases or complaints. CONCLUSIONS: In adolescents aged 13-19 years there was a strong and significant association between self-reported mental distress and AD as well as headache and neck or shoulder pain for both sexes. Although boys reported fewer complaints as AD, they perceived the complaints a heavier burden than did the girls.